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im'H Waste Tire Suivey & Inspection Re SURVEY <br /> State of California <br /> CIWMB 182(New 04104) Page 2 <br /> California Integrated Waste Management Board Inspeeti®n Form BLUE OR BLACK INK PEN <br /> Part C- Facility Information <br /> Business Profile Inspection Details <br /> Inspection <br /> TPID- Report <br /> Site Suffix: 6 3 :3 0 Number: inspection Number on the associated Survey form(Page 1) <br /> SWIS 0 No <br /> Number: Photos Taken 0 Yes <br /> Property Owner <br /> Amaw el-1,y z i 3 s 5 igvv CA <br /> Exempt Business Type (Fill if applicable) Permitted Regulatory Status (Fill one) <br /> 0 PRC§42823.5-Cement Manufacturing Plant with written verification that the facility qualifies for exemption 0 Permitted 0 Exempt <br /> Excluded Business Types(Fill if applicable) <br /> 0 PRC§42808-Permitted Solid Waste Facility(Landfill,Transfer Station) 0 Excluded Unpermitted <br /> 0 14 CCR§18420(a)(2)-Agricultural<5,000 tires incapable of holding water&used for bumpers or ballast Facility Type(Fill one) — <br /> 0 14 C CR§18420(a)(4)-Tire retreading facility with no more than 3,000 waste tires on premises 0 Major WTF (>_5,000 Tires) <br /> 0 14 CC R§18420(a)(6)-Auto dismantler storing no more than 1,500 waste fires for less than 90 days 0 Minor WTF (500-4,999 Tires) <br /> 0 14 CCR§18420(a)(7)&(e)-Tire dealer storing no more than 1,500 waste fires for 90 da)T <br /> Part D-Inspection of Waste Tire Facility <br /> A j WASTE TIRE STORAGE_TANDARDS V A <br /> Permit Requirements 00 14 CCR§17352-Site Security <br /> — 0 0 <br /> 0 0 PRC§42824-Major Waste Tire Facility Permit (a)Signs (b)Site Attendant 0 (c)Access— <br /> 0 0 14 CCR§17353(a)-Vector Control <br /> 0 0 PRC§42834-Minor Waste Tire Facility Permit — 0 (1)Impermeable Barrier 0 (2)Approved Vector Plan <br /> 0 0 PRC§42850(a)-Complies with Terms of Permit 00 14 CCR§17354-Storage of Waste Tires Outdoors <br /> 0 0 14 CCR§18420(a)-Applicable for Permit 0 (a)Storage Units <br /> 0 0 14 CCR§18423-Filing Application for Permit 0 (b)Fire Lanes <br /> 0 (c)Fire District Requirements <br /> 0 0 14 CCR§18432-Operations Plan 0 (d)Drainage <br /> 0 1 0 14 CCR§18433-Emergency Response Plan 0 (e)Slope/Grade <br /> Recordikeeping Requirement 0 (f)Siting(New Facilities) <br /> 0 0 14 CCR§18447-Records Available 0 (g)Rim Removal <br /> 0 Q14 CCR§17351-Fire Prevention Measures 0 (h)Protection from Pyrolytic Oil Runoff <br /> 0 (a)Communication Equipment 0(c)Water Supply Q 0 14 CCR§17356-Indoor Storage <br /> 0 (b)Fire Equipment 0(d)Other Requirements Facility Compliance with NFPA 231D-1989 <br /> Comments <br /> 15386 <br /> INSTRUCTIONS ON BACKCorrect:0 Incorrect: X, 1p_ J X A M2NKLI L2 3 <br /> ■ <br /> Pink Copy:LEA <br /> White Copy:ClWMB Yellow Copy:operator <br />